U.S. patent number 5,752,964 [Application Number 08/633,076] was granted by the patent office on 1998-05-19 for surgical knot pusher with flattened spatulated tip.
Invention is credited to Robert W. Mericle.
United States Patent |
5,752,964 |
Mericle |
May 19, 1998 |
Surgical knot pusher with flattened spatulated tip
Abstract
A surgical knot pusher for pushing a suture knot along a suture
strand, comprising an elongated tube with a flattened tip formed on
the distal end of the elongated tube. The flattened tip is provided
with opposing resilient jaws defining a slot therebetween which
leads to an eyelet defined by the flattened tip for containing an
advancing length of the suture while the suture knot is being
pushed allowing the suture strand to easily enter the eyelet while
preventing the suture strand from exiting the eyelet. A cutting
assembly is slidably mounted within the elongated tube and
comprises a rod with a blade having a straight linear edge mounted
on one end and a handle on the other end. The blade is biased away
from the flattened tip by a spring mounted on the rod, the spring
engaging the flattened tip when the blade is moved toward the
eyelet by pushing the handle toward the tip.
Inventors: |
Mericle; Robert W. (Eden,
NC) |
Family
ID: |
24538190 |
Appl.
No.: |
08/633,076 |
Filed: |
April 16, 1996 |
Current U.S.
Class: |
606/148;
606/144 |
Current CPC
Class: |
A61B
17/0469 (20130101); A61B 17/12013 (20130101); A61B
2017/0474 (20130101) |
Current International
Class: |
A61B
17/04 (20060101); A61B 17/12 (20060101); A61B
017/04 () |
Field of
Search: |
;606/139,144,148 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Buiz; Michael
Assistant Examiner: Pham; T. D.
Attorney, Agent or Firm: Gipple & Hale Hale; John S.
Claims
What I claim is:
1. A surgical knot pusher for pushing a suture knot along a suture
strand, comprising:
an elongated shaft;
a flattened spatulated tip with resilient jaws secured to the
distal end of the elongated shaft;
suture holding means disposed on said flattened spatulated tip for
containing an advancing length of the suture while the suture knot
is being pushed; and
entry means on said flattened spatulated tip for said suture
strand, said entry means comprising said opposing resilient jaws
defining a suture passageway therebetween allowing the suture to
easily enter the suture holding means which is an enclosed eyelet,
while preventing the suture from exiting said suture holding means,
said entry means comprising said suture passageway running from the
distal end of the flattened spatulated tip to said enclosed eyelet
defined by said spatulated tip, the suture passageway providing a
means for the suture to enter said enclosed eyelet and having a
width less than the diameter of the suture, said distal end of the
flattened spatulated tip is provided with a tip notch leading into
said suture passageway, the tip notch being substantially V shaped
with the vertex of the V coinciding with the distal end of the
suture passageway to guide the suture into the suture
passageway.
2. A surgical knot pusher as claimed in claim 1 further comprising
cutting means slidably mounted in said elongated shaft for cutting
the suture strand as it emerges from said eyelet defined by said
flattened spatulated tip; said cutting means comprising a rod with
a blade having a straight linear edge mounted in said shaft and
biased away from said flattened spatulated tip by spring means.
3. A surgical knot pusher for pushing a suture knot along a suture
strand, comprising:
an elongated shaft;
a flattened spatulated tip secured to the distal end of the
elongated shaft;
suture holding means formed on said flattened spatulated tip for
containing an advancing length of the suture while the suture knot
is being pushed;
entry means defined on said flattened spatulated tip for engaging
suture strand, said entry means allowing the suture strand to
easily enter the suture holding means, but preventing the suture
strand from exiting said suture holding means; a cutting means
slidably disposed within said elongated shaft, said flattened
spatulated tip being provided with a cutting means channel which
allows the cutting means to move out of the flattened spatulated
tip toward the suture strand; and cutter moving means disposed
within said elongated shaft for moving the cutting means through
the cutting means channel toward the suture strand emerging from
the suture holding means; said cutting means comprising a flat,
straight-edged blade and said cutter moving means is an actuation
rod slidably disposed within said elongated shaft, said
straight-edged blade being affixed to the distal end of the
actuation rod and the proximal end of said actuation rod extending
from the proximal end of the elongated shaft wherein the angle of
the straight-edged blade relative to the straight-edged direction
of the travel of the blade being changeable so that the
straight-edged blade can slice the suture strand at a desired
angle.
4. A surgical knot pusher as claimed in claim 3 further comprising
biasing means secured to said actuation rod for biasing said
straight-edged blade and said actuation rod toward the proximal end
of said elongated shaft, said biasing means comprising a tensioning
spring positioned adjacent to said actuation rod and secured to a
collar mounted to said actuation rod moving said straight-edged
blade away from the suture holding means when the straight-edged
blade is not in use.
5. A surgical knot pusher as claimed in claim 4 further comprising
spring tension adjusting means for adjusting the magnitude of the
force exerted by the tensioning spring on the actuation rod and
said straight-edge blade to move said straight-edged blade away
from the suture holding means when the straight-edge blade is not
in use.
6. A surgical knot pusher as claimed in claim 3 wherein a surface
of the flattened spatulated tip from the cutting channel to the
suture holding means is planar.
7. A surgical knot pusher for pushing a suture knot along a suture
strand, comprising:
an elongated tube;
a flattened head formed on the distal end of the elongated tube to
provide visibility of the suture strand during cutting, said
flattened head being provided with opposing resilient jaws defining
a slot therebetween; said slot leading to an enclosed eyelet
defined by said head for containing an advancing length of the
suture while the suture knot is being pushed allowing the suture
strand to easily enter the eyelet while preventing the suture
strand from exiting the eyelet;
a cutting assembly slidably mounted within said elongated tube,
said cutting assembly comprising a rod with a straight edged blade
mounted on one end and a handle on the other end; said straight
edged blade being biased away from said flattened head by spring
means mounted on said rod, said spring means engaging said
flattened head when the straight-edged blade is moved toward the
eyelet by pushing the handle toward the head.
8. A surgical knot pusher as claimed in claim 7 wherein the distal
end of the flattened head defines a head notch with a substantially
V shaped configuration, the vertex of the V coinciding with the
distal end of the head slot to guide the suture into the head
slot.
9. A surgical knot pusher as claimed in claim 7 wherein said spring
means comprises a spring holder mounted on said rod, a spring
mounted to said spring holder and extending from said spring holder
toward said head to bias said rod against the force applied to said
handle when the straight-edged blade is pushed toward the eyelet
and transporting said rod away from said eyelet when the force on
the handle is removed.
10. A surgical knot pusher as claimed in claim 7 including limiting
means mounted on said rod to limit movement of the rod when forced
forward by said handle.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates generally to surgical knot tying and
cutting tools, and relates more particularly to a suturing and
ligation tool used during an endoscopic surgical procedure.
The invention is specifically directed toward a surgical knot
pusher designed to push suture knots which have been tied
extracorporeally or outside of the body during a surgical procedure
toward the tissue to be approximated and then to cut the suture
strands once the knot has been tied in the proper position.
2. Description of the Prior Art
The use of knot pushers in surgical procedures to assist with
placement of extracorporeally tied knots to close severed blood
vessels and other small fluid ducts is well known in the art. A
number of prior art patents have been directed toward such surgical
knot pushers.
One such U.S. Pat. No. 5,423,837 issued Jun. 13, 1995 to the
present inventor shows a surgical knot pusher with a truncated
conical tip forming an endwall with a guide opening to accommodate
a suture. The suture enters the opening through a slit and the slit
opens into a complex configured suture slot which is cut into the
side of the conical tip. This knot pusher uses a rigid tube to cut
the suture which does not cut the suture effectively.
Another U.S. Pat. No. 5,269,791 issued Dec. 14, 1993 discloses a
surgical knot pusher having a tapered spiral coil on the tip, with
the respective coils being spaced to receive a suture. The
conically tapered coil narrows to an opening at the end that is
slightly larger than the diameter of the suture but is small enough
to prevent the suture from slipping off the surgical knot pusher.
This surgical knot pusher is not provided with a cutter.
U.S. Pat. No. 5,176,691 issued Jan. 5, 1993 shows a surgical knot
pusher having an opposed pulley-like surface for guiding the ends
of the suture away from the winding of a knot as the winding is
advanced through the portal of an endoscope. This surgical knot
pusher does not use a cutter.
U.S. Pat. No. 5,084,058 issued Jan. 28, 1992 discloses a suture
rundown tool and cutter assembly. The knot rundown tool is in the
form of an elongated shaft with a convex, V-shaped groove formed in
the front end of the shaft. The shaft includes a pair of
diametrically-opposed elongated grooves which intersect the base of
the V-shaped groove and extend rearwardly therefrom and a pair of
diametrically opposed, V-shaped notches formed in the front ends of
the elongated grooves of the shaft.
U.S. Pat. No. 4,961,741 issued Oct. 9, 1990 shows a suture knotting
instrument for forming a double knot. The device consists of two
parts, a leading member and a trailing member, with the leading
member being designed to slide a first knot against the tissue and
the trailing member being designed to slide a second knot against
the first knot. The leading member is designed to part as the
trailing member slides the second knot against the first.
U.S. Pat. No. 4,641,652 issued Feb. 10, 1987 is directed toward an
applicator for tying sewing threads used in combination with an
endoscope tube. The applicator is a hollow coil communicating with
a longitudinal passage through a shaft. This device does not
provide a cutter.
Another U.S. Pat. No. 4,602,635 issued Jul. 29, 1986 is directed
toward a remote surgical knot tier and method of use. The knot tier
can be inserted down a hollow cannula inserted in the skin around
the knee joint. The device uses a cylindrical rod member having an
angularly cast end which may be non-perpendicular to the length of
the rod member. The rod member has a flat face at the end with a
small hole therein to accommodate the passage of a suture
therethrough. This device does not provide a cutter.
Still another U.S. Pat. No. 3,752,516 issued Aug. 14, 1973
discloses a knot tying jig formed of a hollow cylindrical tube
having one or both of its ends cut at about forty degrees to
provide slanted ends. The slanted end or ends are provided with
notches on the center line of the tube and extend transversely
across the slanted ends. A hole is provided in each end of the tube
to accommodate the suture. The jig is not provided with a
cutter.
Surgical knot placement is frequently a difficult task when access
to the wound site is impeded because bodily fluids make the
suturing material difficult to hold and tie. This is particularly
true in laproscopic surgery procedures, where the surgeon is
normally attempting to tie a surgical knot using instruments which
can only access the wound area through the small access ports used
during such procedures. In such cases a surgical knot pusher may be
employed to tighten the suture knot. The surgical knot is first
tied loosely, and then advanced down the loop of suture by the
pusher, resulting in a tight closure at the wound site.
Once the suture needle passes outside of the access port the
surgeon can tie a surgical slip knot outside of the body or
"extracorporeally". Having done this, the knot pusher can be used
to advance the knot toward the tissue through the access port,
while firmly holding the free end of the suture outside the body.
The knot will tighten at the tissue surface and lock in position.
This approach to knot tying, especially in laproscopic surgery
procedures, can significantly benefit the patent and surgeon alike,
reducing the time needed to complete the surgical procedure.
Various knot pushers are available and examples of these have been
previously discussed.
Many prior art devices either require the suture to be threaded
through a small hole or held within the crotch of a fork. Threading
a suture through a small hole is difficult to do during an
operating procedure and is sensitive to the size of the suture.
When the suture is to be held within the crotch of a fork there is
a tendency for the suture to fall out of the V-shaped area. None of
these devices offers the surgeon a means for cutting the excess
suture material from the knot after successfully placing it
adjacent to the desired area. The present invention not only places
the knot, but has its own cutting feature which eliminates the need
for another instrument such as scissors to accomplish this
function.
SUMMARY OF THE INVENTION
The surgical knot pusher device is constructed with an elongated
shaft having a flattened spatulated tip which is slotted and
provided with an eyelet which restricts the suture and prevents it
from falling out of the flattened spatulated tip. The suture is
easily positioned without threading by pushing the slot on the tip
against the suture forcing the suture through the slot and into the
eyelet.
A cutting device is incorporated into the surgical knot pusher, by
providing the inside of the elongated shaft with a movable rod
member which has a cutting blade affixed to the distal end. The
surgeon advances the cutting blade toward the suture by pushing on
an actuator knob mounted on the distal end of the rod member as the
knob protrudes from the end of the elongated shaft. A tensioning
spring is provided within the shaft to maintain the blade in a
retracted position until it is used to sever the suture. When the
cutting blade is advanced toward the suture, it advances against a
counter force provided by the tensioning spring or similar device.
When the suture is cut, the surgeon ceases applying pressure to the
rod and the cutting blade retracts to its original position due to
the force applied by the spring.
It is therefore an object of the present invention to provide a
surgical knot pusher which offers the surgeon simplicity of
use.
Another object of the invention is to provide a surgical knot
pusher which will reliably advance the surgical knot without the
suture material slipping out of the device.
Another object of the invention is to provide a surgical knot
pushing tool which can precisely cut the excess suture material
from the tied knot.
Another object of the invention is to provide a surgical knot
pusher which is easily and inexpensively manufactured.
In the accompanying drawings, there is shown an illustrative
embodiment of the invention from which these and other objectives,
novel features and advantages will be readily apparent.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a side view of the inventive knot pusher device shown
with a missing central portion to illustrate indeterminate
length;
FIG. 2 is an end elevational view of the tip of the knot pusher
device shown in FIG. 1;
FIG. 3 is an enlarged view of the end of the knot pusher device
shown in FIG. 1;
FIG. 4 is a cross sectional view of the device shown in FIG. 3
taken along the line 4'--4';
FIG. 5 is an enlarged cross sectional view of a cut away portion
taken along the line 5'--5' of FIG. 1;
FIG. 6 is an enlarged side view of a schematic representation of
one embodiment of the flattened spatulated tip;
FIG. 7 is an enlarged plan view of the flattened spatulated tip of
FIG. 6;
FIG. 8 is a front end view of the flattened spatulated tip shown in
FIG. 7;
FIG. 9 is an enlarged partial plan view of the flattened spatulated
tip shown in FIG. 7;
FIG. 10 is a plan view of the cutting assembly used with the
surgical knot pusher;
FIG. 11 is a side view of the cutting assembly shown in FIG.
10;
FIG. 12 is an enlargement of the encircled portion of FIG. 11;
and
FIG. 13 is a perspective view of one end of the surgical knot
pusher showing the suture in place in the surgical knot pusher and
a surgical slip knot in place around a blood vessel to be
sutured.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
The invention is now described with reference to an exemplary
embodiment shown in the drawings. The preferred embodiment and best
mode of the invention is shown in FIGS. 1-13.
The surgical knot pusher 10 includes an elongated shaft or tube 12
defining a thoroughgoing bore 13, the shaft having a flattened
spatulated tip 14 on one end defining an eyelet 15 and entrance
slot 17 and a handle 16 mounted at the other end. A cutting
assembly is mounted in the elongated shaft and is formed by an
actuation rod 18 disposed within the elongated shaft 12 extending
from the elongated shaft 12 at one end. Actuation knob 20 is
connected to one end of the actuation rod 18 and a cutting blade 19
is mounted to the other or distal end of the actuation rod 18. The
actuation rod 18 is slidably mounted within elongated shaft 12. A
rear stop 24 is positioned at the proximal end of the actuation rod
18 and is secured thereto to limit withdrawal of rod 18 from shaft
12. A tensioning spring 21 surrounds the lower portion of actuation
rod 18 and is secured to spring anchor 22. Spring anchor 22 and
tensioning spring 21 thereby cooperate to exert a biasing force on
the actuation rod 18 which is directed longitudinally along the
actuation rod 18 toward the actuation knob 20 when the actuation
knob is pushed forward. When the surgeon releases the actuation
knob 20 after severing the sutures, the force from the tensioning
spring 21 slides the actuation rod 18 and the cutting blade 19 back
into a resting position away from the eyelet 15 to the position
shown in FIG. 4. Thus the actuation rod 18 and cutting blade 19 are
in the resting position so that there is a reduced risk of
inadvertently cutting the suture material. This resting position
allows the loading of the suture for another knot pushing
operation. The spring return pressure is controlled by changing the
position of the spring anchor 22 on the rod 18.
FIGS. 3 and 4 show an enlarged top view of the end of the elongated
shaft 12 of the surgical knot pusher 10 showing the tensioning
spring 21 and the flattened spatulated tip 14 in greater detail.
The actuation rod 18 and cutting blade 19 are in a retracted
position with no tension on the tensioning spring 21.
The lower portion of the handle 16 is mounted on the end of the
elongated shaft 12. Actuation rod 18 passes through the handle 16
as it enters elongated shaft 12. The rear stop 24 prevents
actuation rod 18 from being removed from elongated shaft 12.
An actuation rod groove 34 as shown in FIGS. 6 and 7 is cut in to
the tip 14. The actuation rod groove 34 provides a travel path for
the actuation rod 18 as the actuation knob 20 is pressed toward the
handle 16 by the surgeon. The actuation rod 18 moves forward in the
groove 34 until it reaches the end of its travel path, the forward
travel being limited by the actuation rod 18 engaging the end of
the actuation rod groove 34. A cutting blade groove or track 36 is
also shown in dotted line outline. As the actuation rod 18 and
cutting blade 19 move toward the eyelet 15, the cutting blade 19
travels in the cutting blade groove 36.
The relative positioning and approximate dimensions of the eyelet
15, the tip slot 17 and tip notch 39 on the flattened spatulated
tip 4 are illustrated in FIGS. 7 and 9.
A surgical knot pusher showing the suture in place in the surgical
knot pusher and a surgical slip knot in place around a vessel to be
tied shut is shown in FIG. 13. The term "suture" as used in this
application includes ligature and filamentary material which may be
used in a surgical procedure. The cutting blade 19 is shown in its
retracted position in the surgical knot pusher 10 with the suture
40 shown in position in the eyelet 15. When the knot 44 is
tightened around the vessel protruding from the body member 46, the
suture 40 can be severed by the cutting blade 19. During the
cutting procedure the suture is slipped into the eyelet 15 of the
flattened spatulated tip 14 directly behind the knot 44. The knot
44 is snugged against the side of the flattened spatulated tip 14
opposite the cutting blade 19 and advanced to the body member 46.
The thickness of the spatulated tip 14 determines the precise
length of the cut suture tail. The tip thickness can be altered to
idealize this cut length. After snugging the knot 44, the cutting
blade 19 is advanced along the tip surface and severs the suture in
a slicing manner. If desired, the angle of the cutting blade 19 may
be altered so that the cutting blade 19 engages the suture 40 with
a angular slicing motion for improved effectiveness cutting the
suture.
The flattened spatulated tip 14 is preferably made from a resilient
material which allows the jaws 23 defining the tip slot 17 in the
flattened spatulated tip 14 to resiliently expand to permit suture
materials of various diameters to enter the eyelet 15. Once the
suture 40 is positioned in the eyelet 15, the jaws 23 of the
flattened spatulated tip 14 return to normal shape ensuring that
the suture 40 will not come out of the eyelet 15 while the surgical
knot 44 is being pushed. Thus the flattened spatulated tip 14
should exhibit sufficient flexibility and resiliency to allow a
range of suture materials to enter the eyelet 15 through the tip
slot 17 without easily becoming dislodged from the eyelet 15.
Sufficiently springy materials which can be used for the tip
construction can be non-metallic materials such as polymers or
suitable composite materials. Superelastic nickel-titanium alloys,
hard polyurethanes, nylons, polycarbonates, polyetheretherketones,
ultrahigh molecular weight polyethylene can also be used. However,
the flattened spatulated tip 14 may be made of any material and may
constitute a disposable and replaceable part of the device.
The elongated shaft 12 preferably comprises a tube of relatively
stiff material in order to avoid undesirable flexing. Appropriate
materials, such as stainless steel and aluminum, engineered polymer
materials such as polyetheretherketones, polyphenylene oxide,
polyphenylene sulfide and polymer composite such as glass-filled
epoxy resin, carbon fiber-filled epoxy resin, and other suitable
natural or synthetic resin materials can be used.
The cutting blade 19 preferably is constructed with a straight
blade that is beveled on one side and is secured to the actuation
rod 18 by adhesives, sonic welding or other means known in the art.
The cutting blade 19 can have other shapes, however, and the
actuation rod 18 and cutting blade 19 can be manufactured as a
single piece from a single piece of material such as stainless
steel or as separate pieces which are then affixed to one another
as previously noted.
In normal operation of the surgical knot pusher 10, a surgeon will
have sewn a loop of suture material across an incision in a
patient. The two loose ends of the suture material will extend
outside the body of the patient so that a surgical slip knot 44 in
one end of the suture material can be loosely tied around the other
loose end of the suture material. The loose end of the suture at a
position above the knot is aligned with the tip notch 39 and the
flattened spatulated tip 14 is moved toward the suture, forcing the
suture into and through the tip slot 17 and then into the eyelet
15. The surgical knot 44 is located at the opposite side of the tip
14 from the cutting blade 19. The surgical knot 44 is then pushed
with the flattened spatulated tip 14 along the suture strand 40
toward the incision to be approximated. The slack in the loose end
is taken up by the surgeon pulling the loose end of the suture 40
through the eyelet 15 as the knot 44 is being pushed. The surgical
knot 44 is pushed until the suture is tightly closed. The remaining
suture material can be severed by depressing the actuation knob 20
which will move the cutting blade 19 across the eyelet 15, cutting
the suture strand. The thickness of the spatulated tip is designed
to provide suture cutting at a precise distance from the knot.
The principles, preferred embodiments and modes of operation of the
present invention have been described in the foregoing
specification. However, the invention should not be construed as
limited to the particular embodiments which have been described
above. Instead, the embodiments described here should be regarded
as illustrative rather than restrictive. Variations and changes may
be made by others without departing from the scope of the present
invention as defined by the following claims:
* * * * *